Provider Demographics
NPI:1811007842
Name:SMITH, JENNIFER MEAGEN (CPTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MEAGEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:712 ROLLING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3226
Mailing Address - Country:US
Mailing Address - Phone:972-821-2550
Mailing Address - Fax:580-795-7307
Practice Address - Street 1:1100 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2620
Practice Address - Country:US
Practice Address - Phone:580-924-8579
Practice Address - Fax:580-745-9357
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant